What vaccinations are needed for someone my age? (59yrs) have not gotten anything in over 20 years or so.

Depends: For starters a flu shot yearly has value, especially as you get older since complications increase with age. A Tetanus booster, often now given with the whooping cough & diphtheria is worthwhile. If you travel, many countries have specific needs to avoid endemic infectious diseases. A good resource to check is the CDC website. www.cdc.gov/vaccines.